Danza Matteo, Carinci Francesco
Department of Maxillofacial Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
Stomatologija. 2010;12(2):35-41.
Computer planned flapless surgery and immediate loading are the most recent topics in implantology. One new computer-planned implant system uses a three-dimensional parallelometer able to transfer the implant position from the virtual project to the master model. The aim of this study was to verify if the new medical device gives an advantage in term of implant failures and/or crestal bone remodeling.
A retrospective study was planned to analyze a series of 193 immediately loaded fixtures inserted by means of flapless surgery. From those sixty six implants were inserted with computer planning whereas 127 were inserted "free-hand". Several variables related to patient, anatomy, implant, surgery and prosthesis were investigated. To detect the clinical outcome implant' failure and peri-implant bone resorption were considered. Kaplan-Meier algorithm and Cox regression were then performed to detect those variables statistically associated with the clinical outcome.
Implant length and diameter ranged from 10 to 16 mm and from 3.75 to 6.0 mm, respectively. Implants were inserted to replace 46 incisors, 30 cuspids, 75 premolars and 42 molars. The mean follow-up period was 15 months. Seven implants were lost (survival rate 96.4%) but no studied variable has a statistical impact on failures. On the contrary, implants inserted in sites with completed bone healing, wide diameter fixtures and implants inserted in totally edentulous jaw had a significantly lower crestal bone resorption. The other variables (age, gender, upper/lower jaws, tooth site, implant' type and length, number of prosthetic units antagonist condition) did not have impact on crestal remodeling.
Computer-planned and cast model transferred implantology is a reliable technology that provides a slightly higher clinical outcome than "free hand" technique at least in healed sites, wider implants and totally edentulous jaws.
计算机辅助的无瓣手术和即刻种植是种植学领域的最新研究热点。一种新型的计算机辅助种植系统采用三维平行测量仪，能够将种植体位置从虚拟设计转移至工作模型。本研究旨在验证该新型医疗器械在种植体失败率和/或牙槽嵴骨改建方面是否具有优势。
本研究为回顾性研究，分析了193颗通过无瓣手术即刻种植的种植体。其中66颗种植体采用计算机辅助设计植入，127颗为徒手植入。研究了与患者、解剖结构、种植体、手术及修复体相关的多个变量。通过种植体失败情况和种植体周围骨吸收情况来评估临床效果。采用Kaplan-Meier算法和Cox回归分析来检测与临床效果具有统计学关联的变量。
种植体长度为10至16毫米，直径为3.75至6.0毫米。植入种植体用于替代46颗切牙、30颗尖牙、75颗前磨牙和42颗磨牙。平均随访期为15个月。7颗种植体脱落（存留率96.4%），但所研究的变量对种植体失败均无统计学影响。相反，在骨愈合完成的部位植入的种植体、直径较大的种植体以及植入全口无牙颌的种植体，其牙槽嵴骨吸收明显较少。其他变量（年龄、性别、上下颌、牙位、种植体类型和长度、修复单位数量、对颌情况）对牙槽嵴改建无影响。
计算机辅助设计并通过模型转移的种植技术是一项可靠的技术，至少在愈合部位、较宽的种植体和全口无牙颌情况下，其临床效果略优于徒手种植技术。
